University Student Karate Program Registration Form 2026/2027

New or Returning Student?

University Karate Program

Student's Name

First NameLast Name

Student ID required to receive a 10% discount off registration fees.

T-Shirt Size

Preferred Pronouns

If selected other please specify:

Gender

If selected other please specify:

Birth Date

Date

Mobile

Format: (000) 000-0000.

Other Phone

Email 1

example@example.com

Email 2

example@example.com

Health Record: Please specify any which may impact/affect your training

Allergies/Sensitivities

Is there anything else you would like to share about your child?

{studentsName} (hereinafter referred to as the “Applicant”) hereby applies for training in the art of karate from Karate with Aoife (the “Association”).

Iinsert name upon acceptance by the Association of this application, the Applicant agrees to observe all the rules and regulations established by the Association for maintaining order and protecting the Applicants and other Applicants from injury, and to respect the discipline of the instructor.
In consideration of the Association accepting this application for training, the Applicant does hereby remise, release and forever discharge, and by these presents does for themself, executers, administrators, and assigns, remise, release and forever discharge the Association, their agents, servants, officers, instructors, representatives and authorized guests of and from any and all manner of action or actions, cause or causes of actions, suits, claims, cost, expenses and demands whatsoever at law or in equity, including without restricting the generality of the foregoing any and all such claims with respect to death, injury, loss or damage, including special general or consequential damage to the Applicant’s person or property, which they ever had or may now have, or which the Applicant of their executors, administrations or assigns hereafter can, shall or may have by reason of any matter, cause or thing whatsoever arising out of or in connection with or resulting with the Applicant’s association with or the Applicant’s taking part in the activities of the Association, including the Applicant’s training in or participating in the art of karate, notwithstanding that the same may have been contributed to or occasioned by the negligence of the Association, their agents, servants, officers, instructors, representatives or authorized agents, whether acting under the instructions or direction of representatives of the Association or not.

DATED THIS

Date

Signature

In consideration of the Association accepting this application for training, the Applicant hereby expressly grants to the Association and their employees, agents, and assigns, the right to photograph me and use my picture, silhouette, and other reproduction of my physical likeness to and to connection with any purpose and in any manner whatsoever as the Association so chooses in any and all media, in any and all versions, as well as for promotions, merchandising, publicity and advertising.

Individual Membership Registration

University Student Karate Program

Which class do you plan to attend? In order to secure your spot fees must be paid in full before the beginning of the term.

RELEASE , WAIVER and CONSENT

Karate with Aoife

Emergency Contact Information